Where you live shouldn’t determine if you live (American Cancer Society)

If you want to go fast, go alone. If you want to go far, go together (African proverb)

One big areas of focus was the change from communicable diseases to non-communicable diseases (NCD) in lower and middle income nations. Cancer is the largest of them and according to Ambassador Cowal is progressively growing from 8.2 million cancer deaths in 2012 to a projected 13 million cancer deaths in 2030. Cancer is perceived in these nations as not curable, much the same way AIDS was years ago. And because of this situation, there is enormous stigma and shame attached to those who have cancer. Furthermore, 30% of disease mortality from NCDs can be eliminated by eliminating smoking. Other critically important NCD include asthma and other respiratory diseases (chronic obstructive pulmonary disease, for example), diabetes, and the scarcity of potable safe water (arsenic poisoning, and pollution-contamination, for instance).

Another big area of focus was the need and pressure to change business models to make financing for R&D sustainable. Andrin Oswald discussed the idea of for-profit in the US vs non-profit globally as well as efforts to create paths towards sustainability are successfully underway. This reflected an ongoing theme from previous NYPF meetings. He also discussed successful partnerships between and amongst research institutions and pharma companies using TB drug acceleration as an example and specifically highlighted collaborative discovery research towards target identification and lead optimization.

Vaccination is a key part of prevention and Michael Nally focused on Merck’s efforts in this area. He cited how Merck’s HPV prevention vaccine, Gardasil 9, is expanding the scope of prevention, reducing the incidence of cancer and striving towards the elimination of HPV cancers (cervical, rectal, head and neck). Merck is also currently working on creating new paradigms of partnership around drug development towards testing and licensing an Ebola vaccine. Lassa fever virus vaccine, Chikungunya virus vaccine, and Zika virus vaccines are desperately needed as are renewed supplies of Yellow Fever virus vaccine.

BT Slingsby focused on vaccinations and the economic impact they have on averting costs of the illnesses and deaths as well as the flip side of the equation, demonstrating the economic and social value gained. He set-up the discussion about cancer by showing a statistic of global deaths from HIV/AIDS, Malaria and TB (the combined number = 3,038,000) was approximately one-third that of persons infected with NTDs (1 Billion). He also showed a graphic from Lancet (Pedrique B, et al. Oct. 2013) that dramatically bought home the fact that of all the drugs (new chemical entities or NCEs) approved between 2011-2013, only 4, or 1% were for neglected diseases. This number highlights a global issue including orphan diseases (parasitic infections, rickettsial bacterial infections) in the US.

Darren Black focused on trends that impact the global health ecosystem. Three, in particular, resonated with the other speakers’ topics. The first, and in my mind, the most important, was the challenge from evolving from philanthropic models to commercial models. This issue is key because public companies must answer to shareholders who are focused on short-term goals and profits, while companies must have long term horizons to enable paradigm changes. The other two issues were shifting to integrated or horizontal programs in the development and distribution of care and the incorporation of non-traditional players into this evolving ecosystem. Pfizer is focused on treating and eliminating trachoma (an NTD) using Zithromax. He also focused on the issue of infrastructure, facilities and medicines in Sub-Saharan Africa.

The subject of “digital” was raised in name only and not delved-into at all. During the Q&A I asked the panel to discuss digital, citing the fact that there are more cell phones in the world (all over the world) than people and that cells phones can be an effective way to reach the stigmatized and shamed suffering from cancer along with delivering and collecting information. The entire panel was mute except for BT Slingsby, who brought up the key point of adherence (an issue which crosses all national boundaries). He has an MPH degree (Masters in Public Health), which means he is versed in this area. I was surprised that Darren Black didn’t contribute to this discussion at all, since Pfizer had a healthcare IT and outcomes division, Pfizer Health Solutions, from the mid-90’s to the mid-2000’s that was an early pioneer in this area.

It was refreshing to see a global perspective on healthcare. While we in the US are focused on the future of healthcare and its delivery, the rest of the world, especially middle and low income countries, is still struggling with survival issues around healthcare, including such basics as access to clean water, electricity and availability of doctors.